Rebecka Janols Department of Information Technology Uppsala University (Thursday, 1.00pm, Sigma Room)

1. UU/IT
Interpretation and Adoption of the
Concept of Enterprise-wide and Best
of Breed Health IT within the New
Zealand eHealth Community
Rebecka Janols1, Karen Day2 and
Martin Orr2
1Uppsala University 2Universityof Auckland
Department of National Institute for Health
Information Technology Innovation
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2. UU/IT
My research
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3. UU/IT
eHealth in New Zeeland
 Implemented in most areas
 Complex puzzle of IT systems and applications
 Same IT systems differently configured
Changes are required:
 Hard to maintain
 Expensive
 To enable future developments
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4. UU/IT
The NZ Health IT plan (2010)
“set priorities for regional and national IT
investments over a five-year period”
 Shared care record that focuses on the patient and
is shared between the patient and involved care
providers.
 DHBs in the same region need to come together
and agree on a common platform (i.e. a standard
set of software that is used within the region).
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5. UU/IT
“The aim of this paper is to unbundle what
Enterprise-wide and Best of Breed IT means in
the New Zealand health context.”
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6. UU/IT
Methods
 Review of key documents and relevant research
 14 participants from different organisations with
different roles
Clinical Hospital manager/ Service
education IT manager Research Organisation Vendor
1 x x
2 x
3 x
4 (x) x
5 x
6 x x
7 (x) x
8 (x) x
9 (x) x
10 (x) x
11 x
12 x x
13 x x
14 x x
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7. UU/IT
The participants‟ interpretation
“Enterprise sounds like you have one
significant and large all-encompassing
process, program, software. Best of Breed
you are going to have different parts of
different programs attached to maybe a
central source…”
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8. UU/IT
Enterprise-wide is based on
“best practice”
“They have actually looked at: ‘what is
health care? What are we trying to do?
What are the basic sets? How does
medicine really work?’…”
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9. UU/IT
Research definition: Enterprise systems
Health care Enterprise
system system
“Enterprise systems are
commercial software Reality
packages that enable the Enterprise
integration of transactions- system
oriented data and business
processes throughout an
organisation.”
Marcus and Tanis (2000)
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10. UU/IT
Research definition: 'Best of Breed‟
Health care
system
“In the „best of breed‟
approach, the organization
picks and chooses ERP
modules which best support
its business processes from
various vendors.”
Sumner and Bradley (2007)
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11. UU/IT
Best of Breed systems
Benefits Disadvantages
 Customised to a particular  Hard to integrate
purpose  Hard to share data
 Easier to implement change  A complex network of
 Flexibility system
 A degree of individualisation  Problems with upgrading to
newer versions
 To many vendors
 Cost – too expensive to
maintain.
 Innovations stops
 Security holes between the
system
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12. UU/IT
Enterprise-wide systems
Benefits Disadvantages
 Built on "best practice”  „Best practice‟ is defined by
 Easy to share and access the vendor not the users
detailed data  Need to compromise – “one
 One patient – one record size fits all”
 Easier to manage  Flexibility – hard to change
 Standardisation of the data  Users need to adapt to the
 Centrally held data base system
 Ability to interface  Harder to innovate
 The same “Look and feel”  Monopoly – little power over
the supplier
 Security is integrated- not
adhoc  Expensive
 Less duplication
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13. UU/IT
Enterprise-wide vs. Best of Breed
The disadvantages with the BoB are often
mitigated by an Enterprise-wide system.
The disadvantages with the enterprise
systems are often mitigated by the BoB.
 What is the future solution?
Is the answer one or the other?
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14. UU/IT
CONCLUSION 1
‘Best practice’ can be differently interpreted.
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15. UU/IT
Research definition: 'Best practice‟
‘‘The better or best ways of performing a
particular process’’
O‟Leary (2000)*
* O‟Leary DE. Enterprise resource planning systems: systems, life cycle, elecronic commerce
and risk. (Cambridge)
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16. UU/IT
1. „Best practice‟ defined by the users
Health care
system
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17. UU/IT
1. „Best practice‟ defined by the users
Health care “Vision”
system
“Reality”
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18. UU/IT
2. „Best practice‟ for a process
Process X
(Org 1)
Process X IT-system
(Org 2)
process X
(Org 3)
‘‘One process – one system’’
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19. UU/IT
3. Evaluated “best practice”
“.. it has gone through some form of
evaluations and inspections as being the
preferred option”
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20. UU/IT
Does ‘best practice’ exist?
“The idea of best practice builds on the
assumption that there are certain solutions
that are superior compared to others when
solving problems in a certain context. “
Axelsson et al. (2012)*
* Axelsson K., Melin U. and Söderström F. (2012) Analyzing best practice and critical
success factors in a health information system case - are there any shortcuts to
successful IT implementation? In. 19th European Conference on Information
Systems.
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21. UU/IT
Don‟t forget
“Since every organization is unique and has its
certain conditions there are obvious risks that
some of the built-in (best practice) actions and
processes in an IT system do not suit the
organization.“
Axelsson et al. (2012)*
* Axelsson K., Melin U. and Söderström F. (2012) Analyzing best practice and critical
success factors in a health information system case - are there any shortcuts to
successful IT implementation? In. 19th European Conference on Information
Systems.
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22. UU/IT
CONCLUSION 2
All user groups have different
responsibilities, requirements and needs. A
enterprise-wide system is too generic to
adequately meet all users needs.
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23. UU/IT
Findings: Enterprise-wide
systems
can be “too generic”
“The risk is that you develop something that is
so generic that it isn’t particularly useful to
the people who need to use it in a day-to-day
basis. That it collects data at a population
level, a district level…”
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24. UU/IT
Who are the users?
“Everybody!”
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25. UU/IT
Who are the users?
Administrative GPs
staff Physiotherapists
Managers PMOs
Government
DHBs Nurses
“Everybody!”
Physiologists
Hospital physicians
Assistant nurses
Researchers
Patients
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26. UU/IT
What are data used for?
Administrative GPs
staff Physiotherapists
Research
Managers Clinical practice
PMOs
Government
DHBs Nurses
Measure quality “Everybody!”
Physiologists Inform founding
Statistics Hospital physicians
Planning Long term disease register
Assistant nurses
Measure outcome Researchers
Patients
Measure progress
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27. UU/IT
Can all users‟ requirements be
supported by the same system?
Or does
responsibilities, roles, contextual
settings and traditions matter?
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28. UU/IT
CONCLUSION 3
Enterprise-wide vs. BoB is a false dichotomy.
Need to identify what must be customised
and what can be centralised.
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29. UU/IT
 Customisation vs. Centralisation
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30. UU/IT
Future solution 1
“…maybe an enterprise-wide solution but it
allows local adaptation for those users in
different areas/…/I think that they both [ERP
and BoB] have risks and they both have
potentials in them. The devil is in the detail.”
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31. UU/IT
Future solution 2
“…the core aspects of data and functionalities
are placed in an accessible location and they
then feed some of those systems. Then, if it
suits me to have an enterprise
system, absolutely fine, go for it/…/I think
that gives freedom to innovate around the
edge.”
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32. UU/IT
3 conclusions
1. There is not a shared understanding of what
„Best practice‟ means.
2. A enterprise-wide system is too generic to
adequately meet all users needs.
3. Enterprise-wide vs. Best of Breed is a false
dichotomy. The challenge is to identify what
must be customised and what can be
centralised.
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33. UU/IT
Thanks for your attention!
Questions?
Please contact me for future cooperation!
Rebecka.Janols@it.uu.se
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